Optimal treatment often not provided to patients with acute coronary syndromes

Patients who arrive at the hospital with acute coronary syndromes do not always receive the optimal care, according to a study from UC Davis and other institutions.

Studies have shown that patients who arrive at the hospital with acute coronary syndromes benefit from early intensive treatment. However, many patients do not receive optimal management for these conditions, according to a new study presented by UC Davis cardiologist Ezra A. Amsterdam and others at the annual meeting of the American College of Cardiology this past March.

Optimal therapy includes opening blocked coronary arteries by angioplasty and stent placement, or performing coronary artery bypass surgery. Several protective medications, including aspirin and beta blockers, also represent important treatments to inhibit the process that blocks arteries.

However, in their study of more than 130,000 patients with acute coronary syndromes, the researchers found that only about half of the patients received coronary artery stents or had bypass surgery. The other half received medications only, which varied widely, depending on the drug. Four drugs were evaluated, and as few as 23 percent, and as many as 87 percent, received one or more of the drugs. Patients receiving only drug therapy had the highest mortality in the study.

"More widespread application of recommended therapy could provide even more benefit to patients."
— Ezra Amsterdam

Amsterdam, a professor in the UC Davis Division of Cardiovascular Medicine, helped conduct the study with a team of cardiologists from Duke University, Pennsylvania Hospital, the University of Cincinnati and the University of North Carolina. Their study is part of the CRUSADE initiative, a registry of patients treated at 547 hospitals in the United States and coordinated by the Duke Clinical Research Institute in Durham, North Carolina.

During their four-year period of investigation, the researchers noted certain favorable trends in patient management. There were significant increases in the use of coronary artery stents and recommended medications, and the proportion of patients treated only with medications decreased from 31 percent to 26 percent. These findings were accompanied by an 18-percent decrease in hospital mortality in patients treated exclusively with medications during the study period.

“We were encouraged by the improvement in patient management and concluded that more widespread application of recommended therapy could provide even more benefit to patients with acute coronary syndromes by reducing adverse outcomes in these serious conditions,” said Amsterdam.